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Mechanical bowel preparation for elective colorectal surgery: a meta-analysis
Pascal Bucher1, Bernadette Mermillod, Pascal Gervaz
1Clinic of Visceral and Transplantation Surgery, Department of Surgery and Division of Medical Statistics, Geneva University Hospital, Geneva, Switzerland. pascal.bucher@hcuge.ch
Hypothesis:
There is little scientific evidence to support the routine practice of mechanical bowel preparation (MBP) before elective colorectal surgery in order to minimize the risk of postoperative septic complications.
Data Sources:
Trials were retrieved using a MEDLINE search followed by a manual search of the bibliographic information in select articles. Languages were restricted to English, French, Spanish, Italian, and German. There was no date restriction.
Study Selection:
Only prospective randomized clinical trials (RCTs) evaluating MBP vs no MBP before elective colorectal surgery were included.
Data Extraction:
Outcomes evaluated were anastomotic leakage, intra-abdominal infection, wound infection, reoperation, and general and extra-abdominal morbidity and mortality rates. Data were extracted by 2 independent observers.
Data Synthesis:
Seven RCTs were retrieved. The total number of patients in these RCTs was 1297 (642 who had received MBP and 655 who had not). Among all the RCTs reviewed, anastomotic leak was significantly more frequent in the MBP group, 5.6% (36/642), compared with the no-MBP group, 2.8% (18/655) (odds ratio, 1.84; P = .03). Intra-abdominal infection (3.7% for the MBP group vs 2.0% for the no-MBP group), wound infection (7.5% for the MBP group vs 5.5% for the no-MBP group), and reoperation (5.2% for the MBP group vs 2.2% for the no-MBP group) rates were nonstatistically significantly higher in the MBP group. General morbidity and mortality rates were slightly higher in the MBP group.
Conclusions:
There is no evidence to support the use of MBP in patients undergoing elective colorectal surgery. Available data tend to suggest that MBP could be harmful with respect to the incidence of anastomotic leak and does not reduce the incidence of septic complications.
Insights
Mechanical bowel preparation (MBP) before colorectal surgery does not reduce septic complications and may increase anastomotic leak risk. Evidence does not support routine MBP use in elective colorectal procedures.
Area of Science:
- Colorectal Surgery
- Surgical Gastroenterology
- Evidence-Based Medicine
Background:
- Mechanical bowel preparation (MBP) is a common practice before elective colorectal surgery.
- The routine use of MBP aims to minimize postoperative septic complications.
- Scientific evidence supporting MBP's efficacy is limited.
Purpose of the Study:
- To evaluate the effectiveness of MBP in reducing septic complications after elective colorectal surgery.
- To assess the impact of MBP on outcomes such as anastomotic leakage and reoperation rates.
Main Methods:
- Systematic review and meta-analysis of prospective randomized clinical trials (RCTs).
- Inclusion criteria: RCTs comparing MBP versus no MBP in elective colorectal surgery.
- Outcomes assessed: anastomotic leakage, infections, reoperations, morbidity, and mortality.
Main Results:
- Seven RCTs involving 1297 patients were analyzed.
- Anastomotic leak rates were significantly higher in the MBP group (5.6%) compared to the no-MBP group (2.8%) (P = .03).
- Rates of intra-abdominal infection, wound infection, and reoperation were higher in the MBP group, though not statistically significant. General morbidity and mortality were also slightly increased.
Conclusions:
- Current evidence does not support the routine use of MBP before elective colorectal surgery.
- MBP may be associated with an increased risk of anastomotic leak.
- MBP does not appear to reduce the incidence of septic complications and may potentially be harmful.
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